今回は

85歳以上の超高齢者524名に対して

肺炎のリスク因子を調査しています。

3年間の追跡調査を行い

その間肺炎による入院または死亡した人を

目的変数と定義しています。

Poor oral health and hygiene are increasingly recognized as major risk factors for pneumonia among the elderly. To identify modifiable oral health–related risk factors, we prospectively investigated associations between a constellation of oral health behaviors and incident pneumonia in the community-living very elderly (i.e., 85 years of age or older). At baseline, 524 randomly selected seniors (228 men and 296 women; mean age, 87.8 years) were examined for oral health status and oral hygiene behaviors as well as medical assessment, including blood chemistry analysis, and followed up annually until first hospitalization for or death from pneumonia. During a 3-year follow-up period, 48 events associated with pneumonia (20 deaths and 28 acute hospitalizations) were identified. Among 453 denture wearers, 186 (40.8%) who wore their dentures during sleep were at higher risk for pneumonia than those who removed their dentures at night (log rank P = 0.021). In a multivariate Cox model, both perceived swallowing difficulties and overnight denture wearing were independently associated with an approximately 2.3-fold higher risk of the incidence of pneumonia (for perceived swallowing difficulties, hazard ratio [HR], 2.31; and 95% confidence interval [CI], 1.11–4.82; and for denture wearing during sleep, HR, 2.38; and 95% CI, 1.25–4.56), which was comparable with the HR attributable to cognitive impairment (HR, 2.15; 95% CI, 1.06–4.34), history of stroke (HR, 2.46; 95% CI, 1.13–5.35), and respiratory disease (HR, 2.25; 95% CI, 1.20–4.23). In addition, those who wore dentures during sleep were more likely to have tongue and denture plaque, gum inflammation, positive culture for Candida albicans, and higher levels of circulating interleukin-6 as compared with their counterparts. This study provided empirical evidence that denture wearing during sleep is associated not only with oral inflammatory and microbial burden but also with incident pneumonia, suggesting potential implications of oral hygiene programs for pneumonia prevention in the community.

結果は

肺炎発症と関連を認めた因子は就寝時の義歯装着

嚥下困難、認知機能の低下、呼吸器疾患・脳梗塞の既往

低アルブミン及び高CRPだった。

就寝時に義歯を装着した人は

就寝時に装着しない人と比べて

肺炎発症のリスクは2.4倍に増加した。

就寝時の義歯装着は対合歯がない場合の

咬傷防止として有効だが、肺炎予防の観点からは

日中使用している義歯を外さずにそのまま

就寝することは避けるべきと考えられる。

引用文献

T. Iinuma1,Y. Arai,Y. Abe,M. Takayama,M. Fukumoto,Y. Fukui,T. Iwase,T. Takebayashi,N. Hirose,N. Gionhaku,K. Komiyama

Denture Wearing during Sleep Doubles the Risk of Pneumonia in the Very Elderly

J Dent Res 2015;94(3 Suppl):28S-36S